Correlation Between Magnesium Valproate Combined With Sertraline To Improve Non-suicidal Self-injury Behavior And HPG And HPT Axes In Adolescents With Depression

Objective:Non-suicidal self-injury (NSSI) has emerged with increasing frequency among adolescents worldwide in recent years and has attracted widespread attention in the field of mental health,becoming a major public health problem with increasing interest.This study compared the differences in thyroid hormone and sex hormone levels between adolescent depressive disorder patients with and without NSSI behaviors,to investigate the relationship between thyroid hormone and sex hormone levels and non-suicidal self-injurious behaviors in adolescent depressive disorder patients.Meanwhile,this study explored the effects of applying magnesium valproate on thyroid hormone and sex hormone levels,depression severity,and self-injury severity in adolescent depressive disorder patients with non-suicidal self-injurious behavior,in order to find the risk factors for the occurrence of non-suicidal self-injurious behaviors in adolescent depressive disorder patients,as well as to explore the effects of applying magnesium valproate to treat adolescent depressive disorder patients with NSSI behaviors and the effects on hormones in body.Methods:A total of 242 patients aged 12 to 18 years who met the diagnostic criteria of persistent depressive disorder in DSM-5(Diagnostic and Statistical Manual of Mental Disorders,5th Edition) and were hospitalized in the children’s ward of Shandong Mental Health Center from January 1,2021to December 31,2021were collected.Using the OSI(Ottawa self-injury inventory) to assess the presence of self-injurious behaviour in the last year,adolescents with depressive disorder with NSSI behaviour were set as the NSSI group of 156 and those with depressive disorder without NSSI behaviour were set as the non-NSSI group of 86.The NSSI group was also divided into experimental and control groups according to the random number table method,with a total of 75 in the experimental group and 81 in the control group.The control group was treated with oral sertraline monotherapy and the experimental group was treated with a combination of magnesium valproate extended-release tablets orally on top of the control group.General information was collected from the enrolled patients,followed by assessment of the patients on the scales:OSI (Ottawa self-injury inventory),The Modified version of Adolescents Self-Harm Scale,HAMD-17 (Hamilton Depression Scale-17 item).Patients’ morning fasting venous blood levels of sex hormone six and thyroid hormone five were measured and analysed the day after admission.The NSSI group was assessed again after 6 weeks of treatment with biological indicators,HAMD-17 and The Modified version of Adolescents Self-Harm Scale.General information,sex hormone and thyroid hormone levels and scores on each scale were analysed using SPSS 26.0 statistical software.Results:1.Of the 242 adolescents with depressive disorders collected,64.5% (156/242) had experienced NSSI behaviours within the last year.The incidence of NSSI was higher in females than in males (P <0.05).HAMD-17 scores were higher in the NSSI group than in the non-NSSI group (P <0.001).There was no significant difference in mean age and years of education between the two groups (P>0.05).2.At baseline,in women,FT4 (free thyroxine),T (testosterone) and PRL (progesterone) levels were significantly higher in the NSSI group than in the non-NSSI group,and TSH (thyroid-stimulating hormone)levels and FT3/FT4 levels were significantly lower than in the non-NSSI group (P <0.05).In men,FT4,T and PRL levels were significantly higher in the NSSI group than in the non-NSSI group,and FT3 (free triiodothyronine),TSH levels and FT3/FT4 levels were significantly lower than in the non-NSSI group (P <0.05).3.Severe depression,high levels of FT4,and low levels of TSH were independent risk factors for the development of non-suicidal self-injurious behaviour in female adolescents with depression;severe depression,low levels of TSH,and high levels of T were independent risk factors for the development of non-suicidal self-injurious behaviour in male adolescents with depression.4.In the NSSI group,pre-treatment self-injury questionnaire scores were significantly positively correlated with FT4 and T levels at baseline in women (P <0.05),and post-treatment self-injury questionnaire score reduction rates were significantly positively correlated with FT4 difference and T difference in women (P <0.05);pre-treatment self-injury questionnaire scores were significantly positively correlated with T levels at baseline in men (P <0.05),and post-treatment self-injury questionnaire score reduction rates were significantly positively correlated with FT4 difference and T difference were significantly positively correlated (P<0.05).5.After 6 weeks of treatment,the levels of TT4 (tatal thyroxine)and PRL were significantly lower in the experimental group than in the control group for women (P <0.05),and the levels of TSH were significantly higher in the experimental group for women (P <0.001);the levels of TT4 and PRL were significantly lower in the experimental group for men (P <0.05),and the levels of TSH were significantly higher in the experimental group for men (P <0.001).6.The HAMD-17 and The Modified version of Adolescents Self-Harm Scale scores decreased in both the experimental and control groups after 6 weeks of treatment,and were significantly lower in the experimental group than in the control group (P <0.05).7.Multiple linear regression showed that whether or not magnesium valproate was applied was an influential factor in the change in TT4,TSH and PRL levels before and after treatment (P <0.05).Conclusions:1.Changes in thyroid hormone and sex hormone levels were associated with non-suicidal self-injurious behavior in adolescents with depression,and there were significant gender differences in the association between thyroid hormone and sex hormone levels and NS SI.2.Regardless of gender,low levels of TSH are an independent risk factor for the development of non-suicidal self-injurious behavior in adolescents with depression.3.Magnesium valproate can assist sertraline in improving the severity of depression and self-injury in adolescent depressive disorder patients with NSSI behaviours,and also has an effect on the patients’thyroid hormone and sex hormone levels.